In hospital and intermediate term outcome of percutaneous coronary intervention using drug eluting stents in elderly patients

Coronary artery disease [CAD] in elderly patients presents a challenging medical problem as regards diagnosis and management. Percutaneous coronary intervention [PCI] proved to be effective in restoring coronary blood flow regardless of patient age; however, the periprocedural risk is also increased due to complex lesion morphology. Durg eluting stent [DES] is an effective tool to avoid re-intervention in the elderly. Evaluation of PCI results in the elderly who received DES; both in hospital [before patient discharge] and up to 6months post procedure. Present study included 34 elderly patients aged >/= 65years old [group I] and 74 patients aged <65years old [group II] in the period from February 2007 to March 2008. All patients underwent coronary angiography and PCI and received at least one DES. Both patient groups were followed up in-hospital for procedure outcome and MACE and till 6 months post procedure in the outpatient clinic. Patient's characteristics, risk factors, and clinical presentation were evaluated and reported. Lesion number and morphology were recognized and classified according to ACC/AHA PCI guidelines. QCA analysis was performed before and after stent deployment to obtain the following: RVD, MLD, percent diameter stenosis, lesion length, and acute gain. The primary end points were death, MI, and target vessel revascularizarion [TVR]; the secondary end point was stent thrombosis according to the ARC definition. Patients were followed up clinically up to 6 months and the data were reported and compared in both groups. The mean age of group I patients was 69.5 +/- 3.7 years vs. 52.7 +/- 8.2 in group II. Both groups were matched with regards to gender distribution, ACS presentation, and major risk factors [p<0.05]. Associated co-morbid conditions such as renal failure, peripheral vascular diseases, and stroke were very low among the study population. The mean EF was 47 +/- 6 in both groups. The LAD was the most prevalent culprit vessel in both groups [61.8% in group I vs. 56.8% in group II, p=0.27]. The stent: lesion ratio was 1:1, and the stent: patient ratio was 1.4:1 in both groups. Taxus stent was the most commonly used DES in this study [54.5% in group I vs. 43.2% in group II] p>.0.05. The two groups had comparable distribution of type A, B, and C lesions. Tirofiban was used in only 21.2% in group I vs.13.5% I group II, p>0.05. The mean stent length was 19.6 +/- 7mm in group I vs.20.3 +/- 6mm in group II, p>0.05]. The mean stent size was 2.95 +/- 0.3mm in group I vs. 2.99 +/- 0.3mm in group II, p>0.05. The mean QCA analyses were comparable in both groups. The angiographic success was comparable in both groups [94.1% in group I vs. 98.6% in group II, p=0.28]. The procedural success was similar in both groups [94.1% in group I vs. 94.6% in groupII, P=0.5].The incidence of in-hospital MACE was low in both groups [3.1% in group I vs. 5.4% in group II, p>0.05]. Stroke rate was found in 1.4% in group II. The primary end points on 6 months follow up were 5.9% in group I vs. 6.8% in group II, p>0.05. Stent thrombosis and vascular complications were very low [1.4% for each] and found only in group II. With DES in the elderly is feasible, safe and effective compared with the younger age group. Patients with mild LV dysfunction, low associated co-morbid conditions and with even distribution of coronary lesion types have similar MACE post procedure. The primary end points within 6 months follow up are not significantly different from younger age groups

Prehospital thrombolytic therapy prior to percutaneous coronary intervention a comparative study with conventional approach in acute ST-segment elevation myocardial infarction

Early revascularization post Ml is the corner stone in the therapy of acute myocardial infarction. Primary PCI proved itself in the management of STEMI with patency rate more than 90%.However, not every hospital has PCI facility. New thrombolytic agent [tenecteplase] is now available which can be given easily outside hospital [Prehospital] to facilitate PCI and preserve the cardiac muscle. comparing primary PCI results in patients with STEMI when tenecteplase was given prior to intervention as early as possible [Prehospital], with those who had only PCI without thrombolytic therapy. the presenting study included 60 patients, divided into two equal groups, group I patients received tenecteplase followed by primary PCI and group II underwent primary PCI only in acute STEMI. 12 leads ECG, cardiac enzymes, echocardiographic study, and coronary angiography were done for all patients. PCI results were recorded in addition to immediate and 6 month follow up. All patients received the same adjuvant medical therapy [aspirin, clopidogrel, heparin and tirofiban if needed]. both groups showed non significant differences in peak cardiac enzymes, ejection fraction before and after PCI, and angiographic success post PCI. The hard end points [death, MI] did not show statistical difference between both groups both inhospital and on follow up. However group I showed significant difference [P < 0.05] in more direct stenting, less procedure time, and more recurrence of chest pain post PCI compared with group II. There were highly significant differences [P < 0.001] in favor of group I in more TIMI 3 flow, less thrombus burden, and less pathological Q waves; and in favor of group II in more clinical success post PCI without complications. The call to balloon interval was shorter in group II [P < 0.05]. No major bleeding was seen in both groups facilitated PCI has the advantages of decreasing thrombus burden in acute STEMI, decreasing procedure time and achieving more TIMI 3 flow; however the hard end points are not different from primary PCI and the recurrence of chest pain is significantly more with facilitation. Tenecteplase use is not associated with major bleeding before PCI

Value of ST - segment elevation in predicting infarcts size and left ventricular function at discharge in patients with perfused acute anterior myocardial infarction

The electrocardiogram [ECG] is simple and non-invasive and can be recorded at bed side, its role in the diagnosis of acute myocardial infarction [AMI] is well established. We are aiming through this study to assess the predictive value of ST segment elevation pattern in reperfused anterior myocardial infarction as an index of infarct size and left ventricular function [LVF]. The study was conducted on 40 patients who were admitted to the Coronary Care Unit of the National Heart Institute between October 2000 and may 2001 with the diagnosis of first time acute anterior wall myocardial infarction. All patients included in the study were submitted to: Full history taking and clinical examination, laboratory investigation including: Serum cardiac enzymes CPK, LDH on admission, at 6 hour intervals for the first day and then daily until discharge, standard resting 12 electrocardiogram A 12 lead ECG was recorded immediately before reperfusion. Evaluation and classified the shape of ST elevation in V3 into 3 types: Concave type: ST-T segment rise with downward convexity group I, 2] straight type: ST-T segment raised obliquely like an inclined plane group II and convex type: ST-T segment rise with upward convexity Left ventricular function was evaluated by echocardiography: The left ventricle was divided into segments wall motion score is assigned [or each segment. Left sided cardiac catheterization with coronary angiography was performed to all patients within 2 weeks after the onset of infarction coronary artery patency was determined by TIMI grade 2,3. The grade of collateral filling in the LAD was evaluated according to the criteria of Rentrop et al. [no 0, visible filling of any collateral channel; 1] filling only of side branches without visualization of the epicardial segment; 2] partial filling of the epicardial segment; 3] complete filling of the epicardial segment, a good collateral channel was defined as grade 2,3 and poor collateral channel as grade 0 or 1. There was no significant difference in the smoking between the 3 groups regarding smoking, hypertension, Diabetes Mellitus and dyslipidemia. The infarct related artery [IRA] was the left anterior descending in 4.0 patient [100 percent of cases]

Cardiac affection in rheumatoid arthritis patients. the impact of disease duration and activity

Twenty-five patients affected by rheumatoid arthritis [RA], according to the American Rheumatoid Association [ARA] criteria, were selected for this study without an evidence of cardiac disease and compared with 32 normal matched subjects. All patients and controls were submitted to M-mode, two-dimensional, Doppler and color Doppler [continuous and pulsed wave] echocardiography. The diastolic parameters including transmitral flow [the ratio between the peak of early diastole [E] and late diastole [A] flow velocity [E/A ratio]], isovolumic relaxation time [IVRT] and deceleration time of E wave [DT], pulmonary venous flow velocity [the ratio between peak pulmonary venous flow velocity during systole [S] and peak pulmonary venous flow velocity during diastole [D] [S/D ratio]] and peak reverse pulmonary venous flow velocity at atrial contraction [a-PW] were evaluated. RA patients underwent a full clinical assessment with a special emphasis on the nature of joint affection, duration of joint morning stiffness, disease duration and health assessment questionnaire. Laboratory investigations, especially ESR and RA factor titer, were done for RA patients group